Do You Really Need to Lose Weight?

Ask Glen!

Q. Glen I think I am fat should I go on a diet?

A. 7 questions that can help you decide

So your favorite jeans have gotten a bit too close-fitting for comfort. Maybe you don't cut quite the figure in your bathing suit that you did a few years ago.

But do you really need to lose weight? Are you putting your health in danger -- or just carrying around a little harmless extra padding?

The standard answer is that you're overweight if your body mass index (BMI) is 25 or higher and obese if your BMI is 30 or higher. But some new research is confusing the weight-and-health issue a bit.

A study published in the April 20 issue of The Journal of the American Medical Association (JAMA) found that people whose BMIs put them into the overweight category actually had a lower risk of death than people in the normal-weight group. (People who were considered obese still had an increased risk of death.)

"When we looked at the overweight group … we found that that group was associated with fewer than the expected number of deaths," says study author David F. Williamson, PhD, senior epidemiologist at the Diabetes Division of the CDC. Does that mean that if you're overweight, but not obese, you should quit worrying about dropping the extra pounds? Experts who spoke to WebMD gave us some answers -- along with seven questions you should ask yourself.

• What is your lifestyle? Regular physical activity and healthy eating are important, no matter what your weight or your BMI.
• What is your family history? If a close relative has a history of high blood pressure, heart disease, diabetes, or other weight-related ailment, it's crucial to be mindful of your weight.
• What is your weight history? People who have consistently gained weight over the years need be careful. Experts say your BMI should not increase dramatically, even as you age. Even moderate weight gain in adulthood can increase your risk of diabetes.
• How is your weight distributed? Weight gained above the hips -- the so-called "apple" shape -- can be problematic. In both men and women, bigger abdomens can signal trouble.
• What is your waist size? The National Institutes of Health has determined that a waist circumference of over 40 inches in men and over 35 inches in women signifies a health risk, particularly in people with BMIs of 25-34.9 (the overweight category). Clothing size is not a good indicator of weight or health, since sizes vary with different manufacturers. But you can use your own clothing -- maybe a favorite pair of pants -- as a personal gauge of your weight.
• What is your health profile? If your cholesterol and blood pressure levels are high and your BMI falls into the overweight or obese category, it's important to lose weight. If your BMI is in the high end of healthy or in the low overweight range, it's a good idea to talk to your doctor about whether weight loss is right for you.
• How do you feel? Seriously consider weight loss if you are overweight and have joint problems, shortness of breath, or other health troubles that limit your day-to-day living.

The Body Mass Index

To understand the issue of weight and wellness, you first need to understand the BMI, the common measure of fatness that is at the heart of the debate.

To find your BMI, you multiply your weight (in pounds) by 705, then divide twice by your height (in inches). A BMI of:

• 18.5 or less is considered underweight
• 18.5-24.9 is considered ideal weight
• 25-29.9 is considered overweight
• 30 or higher is considered obese

Many doctors and researchers say the BMI is a useful tool to determine whether someone is overweight or obese, though they concede it has limitations. But critics say the BMI is an inaccurate gauge of wellness.

"This overweight category of body mass index of 25 to 29.9 is a phony category. It doesn't have medical justification," says Paul Campos, JD, a law professor and author of The Diet Myth: Why America's Obsession with Weight Is Hazardous to Your Health.

Campos says the BMI was developed as a statistical sorting tool for researchers and was never meant as a gauge for weight loss.

"It just doesn't make sense," he says, pointing to muscular celebrities such as Matthew McConaughey and Brad Pitt, who he says would be considered too heavy based on their BMI numbers.

The well-muscled and the big-boned have often found themselves in the BMI's overweight or obese categories, a frequent criticism of the body fat measurement. Indeed, one recent study found that more than half of National Football League (NFL) players were obese according to their BMIs.

Patrick M. O'Neil, PhD, director of the Weight Management Center at the Medical University of South Carolina, agrees that BMI numbers alone should not be used to determine whether someone needs to lose weight. It's important to believe one's eyes, he says.

However, O'Neil believes the BMI is generally a good clinical tool for initial screening.

"The BMI is an excellent tool for helping you figure out where you are," he says. "It's a lot less useful for helping you figure out where you personally need to be."

Weight and Health

How does weight affect health? If you fall into the obese category, the evidence is pretty clear.

The April 20 Journal of the American Medical Association study reports that obesity is responsible for an estimated 112,000 deaths per year. Other studies have shown that obesity puts people at higher risk of health problems such as diabetes, heart disease, and osteoarthritis.

But even people who are obese may not need to drop much weight to improve their health.

"You don't need to lose a lot of weight in order to be healthier," says Cathy Nonas, RD, spokeswoman for the American Dietetic Association. Whether you weigh 200 pounds or 400, "the first 10% of weight that you lose … that's the most significant improvement in your health profile that you're going to see," she says.

The Medical University of South Carolina Weight Management Center also recommends an initial loss of 10% of body weight, O'Neil says. "We know that's an amount of weight loss that can be achieved by most people."

More

On the contrary, Campos says he's combed the scientific literature and has found little evidence that shows weight loss is what matters with health.

"The idea that you have to be thin or so-called ideal weight in order to be healthy is just a completely bogus notion," he says. "If you compare people who have a healthy lifestyle to people with an unhealthy lifestyle, the people with the healthy lifestyle have low relative risk and the people with the unhealthy lifestyle have high relative risk, and this is true without regard to weight."

To illustrate his point, Campos refers to another study that appears in the April 20 issue of JAMA. That study showed that heart disease risk factors such as high blood pressure, high cholesterol, and smoking have declined in all BMI categories in the last 40 years.

"So-called obese people have (fewer) risk factors in terms of cardiovascular disease now than so-called ideal-weight people had 20 years ago," says Campos. He says that it's a person's lifestyle, not his or her weight, that has the most effect on health.

Williamson agrees that lifestyle is important for good health. But he says obesity remains a serious condition, even with improvements in heart disease risk factors. Those improvements don't extend to diabetes, which is linked to excess weight and which continues to increase in the general population.

The increased risk of diabetes that comes with being overweight can be improved with even small amounts of weight loss, says Nonas. She adds that being overweight can also put a strain on the joints, heart, liver, and kidneys.

Nonas casts a skeptical eye on the recent JAMA studies' findings on lower death risk for the overweight and on improvements in heart disease risk factors for the overweight and obese.

"We have of late developed all these wonderful medications which can keep a person alive and keep their cholesterol down, but it doesn't mean that they're healthy," says Nonas. "We have heart attacks and neuropathies (nerve problems caused by diabetes), and just because we can keep them alive, it doesn't mean that we can keep them alive in a way in which any of us would really want to live."

Who Should Lose Weight?

Tara Gidus, RD, a spokeswoman for the American Dietetic Association, says it's possible to be fit and fat -- and that's better than being unfit and fat. But if you're overweight, she says, you still need to lose weight.

The best time to start thinking about weight loss, says Gidus, is when you hit the BMI range of 25 to 27 -- overweight and heading into obesity.

Another expert, Vincent Pera, MD, director of the Weight Management Program at Brown University's Miriam Hospital, says the question of whether someone needs to lose weight must be determined on a case-by-case basis. That's because everyone's bodies and health profiles are different.

Also, he says, there are still a lot of unknown factors about obesity.

"We don't understand all the causes of obesity, and why it is so difficult for some people to control their weight," says Pera. "We don't understand why some people with obesity have so many problems and others don't have those problems."

Please consult your physician before starting any diet or exercise program

Wishing You Great Health,

Glen Edward Mitchell

Got a question? Ask Glen!